Things That Go Bump In The Night
A mother’s instincts and a quick-thinking pediatrician's expertise combined to save the life of a child with symptoms rare for her condition.
Two years after her alarming diagnosis and near-devastating outcome, 9-year-old Sabrina Schmidt (above) is a happy, healthy little girl.
Doctor: Robyn Matloff, MD, Pediatric Nephrologist, Maria Fareri Children’s Hospital, a member of the Westchester Medical Center Health Network
Patient: Sabrina Schmidt, 9, Patterson
Diagnosis: Henoch–Schönlein Purpura (HSP)
One evening in March 2015, shortly after going to bed, then-7-year-old Sabrina Schmidt emerged from her bedroom and told her mother, Monica: “Mommy, I have bumps on my leg.”
Monica observed five large, itchy hives that “looked like they were bleeding under the skin.” Somewhat alarmed, she applied Benadryl and made appointments the next morning with Sabrina’s pediatrician and the family dermatologist. That day, Sabrina was limping, and her legs were covered in bruises and “hundreds of tiny red dots,” recalls Monica. The dermatologist who examined her immediately ordered a skin biopsy and called every doctor and nurse in the practice to weigh in.
“The symptoms were scary because all of the spots showed up on me, and it looked really weird,” recalls Sabrina. Later, at the pediatrician’s office, the mysterious skin condition was finally identified: Henoch–Schönlein purpura (HSP). An autoimmune disease that most commonly occurs in children, HSP causes severe inflammation of the blood vessels. In a small number of cases, Monica was told, the disease could attack the kidneys. She was assured that the HSP would run its course without treatment and that she shouldn’t worry.
Sabrina and Dr. Robyn Matloff.
Monica’s maternal instincts, however, told her otherwise. She made an appointment with Robyn Matloff, MD, a pediatric nephrologist at Maria Fareri Children’s Hospital. “I was the lunatic mom,” says Monica, recalling her increasingly urgent search for answers as Sabrina’s pain worsened, and her walking became impaired. Her bruises persisted and expanded, and “were black as night,” recalls Monica.
With uncanny timing, the day before her nephrology appointment, Sabrina developed swelling throughout her body. Dr. Matloff immediately ran urine and blood tests, and had the child admitted to the hospital. “Sabrina was losing so much protein in the urine that her blood protein levels were alarmingly low. I was very worried about her,” Dr. Matloff recalls.
Dr. Matloff performed a kidney biopsy which revealed the presence of “crescents,” which indicated she was at risk for rapidly losing renal function. Fortunately, there was no scarring, which meant that, with aggressive treatment, Sabrina could avoid the need for a transplant or dialysis. The severity of her disease was so rare, there is no set protocol. Sabrina was given a pulse of high dose IV steroids and then was placed on additional immunosuppressive medication for 15 months.
Today, Sabrina’s kidneys are functioning perfectly. “She did great,” says Dr. Matloff. “Within a month of treatment, her urine protein levels were reduced by half. After three months, they were completely normal.”
Sabrina, who enjoys art and music, also got to participate in her first-ever ski-team race last winter. “I can do everything now,” she says. “I’m healthy, and I’m happy.”
While Dr. Matloff still monitors Sabrina closely, with routine follow-ups, Monica says, “I feel in my heart of hearts that this is behind us. She’s the picture of health.”